The “overdose epidemic” that so many Americans are talking about isn’t really a single epidemic. It’s actually several of them, something we began exploring when we graphed the yearly counts of overdose deaths for the last 40 years.

It turns out that, when totaled, these sub-epidemics trace a nearly perfect exponential growth curve. For four decades, overdose deaths have been growing, doubling about every eight years.

In the aggregate, overdose deaths have been growing at a remarkably smooth and predictable rate, but the underlying patterns of overdose deaths from specific drugs are heterogeneous and unpredictable.

We think that deep forces are holding the multiple sub-epidemics together into a smooth exponential trajectory.

Some of these may be economic and technological “push” factors, such as

increasingly efficient processes for making drugs,

improved communications aiding faster and more targeted delivery of drugs,

higher drug purity, and

lower prices.

At the same time, there are probably strong “pull” factors at work, especially

widening economic disparities,

loss of a sense of purpose, and

dissolution of communities.

I’m excited to see that researchers studying the current mislabeled “opioid crisis” are pointing to socioeconomic causes for overdoses and renouncing the current policy focus and blame on opioid drugs specifically.

…if the current epidemic of opioid overdoses is a manifestation of long-term ongoing processes, then policies aimed mainly at opioid control and treatment may not be enough to permanently bend the overdose death curve downward in the future.

Without also focusing on

social determinants of economic disparity,

reinstating a sense of purpose, and

rebuilding communities,

history indicates that the growth curve for overdose deaths will look increasingly grim.

And that’s exactly what we’re seeing. While policies are narrowly focused on prescription opioids and cruelly restricting their medical use, illicit fentanyl is now what’s killing most people, and methamphetamine and cocaine are making a comeback.

This is what happens when public health policy becomes political theater.

Authors:
Hawre Jalal, M.D., is an assistant professor of health policy in the Department of Health Policy and Management and a researcher in the Public Health Dynamic Laboratory, both at the University of Pittsburgh.
Donald S. Burke, M.D., is dean of the University of Pittsburgh’s Graduate School of Public Health, associate vice chancellor for global health, and professor of global health and health science and policy.

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